Manufacturer/Assembler Quote
Company Name:
Contact Name:
   
Address:
 
City:
State:
   Zip: 
   
Email Address:
Phone Number:
   
Organization Type:
Sole Proprietor
Partnership 		     Corp
LLC
   
Number Of Employees:
   
Describe the Nature Of Your Business:
   
Real Estate Owned (Skip if you don't own any real estate)
Address:
 
City:
State:
   Zip: 
   
Type of Construction:
Sprinklered:
Security System:
Describe the Type of Building:
Describe All Occupancies:
   
Personal Property Owned
Personal Property is property that is kept at a fixed location. The manufacturer usually has 3 types of Personal Property. Each must be insured differently
     1. Raw material to be used in the Manufacture of the products.
     2. Finished Products.
    3. Machines, Equipment, Etc. used to manufacture the product.
Raw Material Total Value: $
Finished Product Total Value: $
Machinery & Equipment Total Value: $
Describe any property stored off premises:
   
Desired Coverages
Building Amount:
Contents Amount:
Loss of Income:
Deductible:
Limit of Liability:
Describe Other Coverages Desired:
Desired Effective Date: (mm/dd/yyyy)
   
Current Policy Information
Renewal Date: (mm/dd/yyyy)
Insurance Company:
Current Premium:
Describe any Losses in the Past 5 Years: